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Curbside Consult with Dr. Jayne 9/5/11

September 5, 2011 Dr. Jayne 2 Comments

Today is Labor Day, which according to the United States Department of Labor, is dedicated to the social and economic achievements of American workers. I decided to spend a bit of time crunching numbers from the Bureau of Labor Statistics. The BLS predicted that healthcare would generate 3.2 million new wage and salary jobs between 2008 and 2018.

The Bureau also predicted that computer systems design and related services would be one of the fastest growing industries in the economy. Management, scientific, and technical consulting services were forecast to be the fastest growing, with an 83% increase.

Of course, a recession has a way of throwing a wrench into things, but I’d be interested to see how far off the mark these numbers are when it’s all said and done. ARRA and HITECH legislation have had and will continue to have a significant impact on employment in the healthcare IT segment.

The industry continues to move at high speed, not only on the development side, but in implementation as well. For the latter, I worry that too many organizations are moving at a pace that is foolhardy. Every day I hear another horror story from a colleague.

There was the one about the hospital that didn’t have their support structure figured out just four six weeks before their scheduled go-live on clinical documentation. Numerous project members tried to call a “time out” to arrange appropriate resources, but leadership forged ahead anyway in order to be able to go-live before a competitor. Physicians had no super users or trainers on the floors to help them, just a call center number.

Then there was a facility that didn’t have all the end-user hardware in place for a CPOE go-live, but went live anyway. Physicians were frustrated and actively developed ways to circumvent workflow, including hiding from nurses and phoning verbal orders from the doctor’s lounge. Juvenile, but understandable.

My personal favorite is from a small primary care practice. A few weeks prior to go-live, a competing practice hired away several key staffers. The practice used a temp agency to quickly fill the positions and stayed with their original go-live data. The temporary staffers had only a few hours of training and the practice didn’t block patient schedules to allow time for documentation. Tempers flared and staff refused to return to the assignment, making matters worse. Rather than pausing to regroup, the providers elected to continue to try to implement.

I don’t understand why anyone thinks that continuing to steamroll ahead when these situations come up is a good idea. Sure, some people continue to drive their cars with the “check engine” light on, but this is the equivalent of driving not only with a dashboard light illuminated, but also with a flat tire and smoke coming from under the hood. I can’t imagine that these same physicians would start a surgery with missing instruments or with a scrub tech who has never done the scheduled procedure.

It is folly to try to implement with an untrained staff, a recognized lack of hardware, or without an appropriately scaled support structure. It doesn’t matter how much time, money, or effort has been invested in the planning – it’s simply a recipe for disaster. If you are on one of these runaway freight trains, you know what I’m talking about.

October is approaching and many eligible providers and hospitals are going to try to achieve Meaningful Use attestation in the last 90 days of the year. I imagine I’ll continue to hear lots of stories from the field, as organizations that are simply not ready move forward, no matter the cost or chaos.

Have a war story to share? E-mail me.


E-mail Dr. Jayne.

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Currently there are "2 comments" on this Article:

  1. “ARRA and HITECH legislation have had and will continue to have a significant impact on employment in the healthcare IT segment.”

    It all depends- most likely this bureaucratic maneuver will result in a “cash for clunkers” increase in activity followed by an aftermath lull in activity. Some physicians may have come on-board when they may have waited otherwise, but with the published 40-80% deinstallation rates, practices which may become disheartened will pull back. Also, we are now seeing growth in a small percent of the IT vendor base- many of the smaller EHR companies are not doing as well as the Allscripts, Epic, GE, Seimens, NextGen, and eCW out there.

    Deinstallations happened in Arizona after Janet Napolitano’s push for EHR resulted in costly deinstallations (http://www.healthcareitnews.com/news/study-deinstallation-emrs-phoenix-could-be-trend ). It’s happened in other government-pushed industries too, including the wind turbine industry- Obama’s praised Cardinal Fastener & Specialty Co just filed for Chapter 11 a month ago (URL- http://nation.foxnews.com/wind-power/2011/08/05/wind-turbine-maker-who-obama-praised-files-bankruptcy ).

    You simply can’t push technology if it’s not wanted or counterproductive and used to render some useless reporting data and extra work.

    Just like in as little as 2 years ago many “enterprise” EHR systems were realing when their stock prices dropped up to 60% of their values (see “CCHIT Hall of Shame” here- http://www.box.net/shared/rgx5m7me10 ) and many had to result in massive layoffs (s.a. Seimen’s IT division- http://www.eweek.com/c/a/IT-Management/Siemens-Plans-4200-Layoffs-from-IT-Division-769235/), I fear that the same history will repeat itself when the EHR bubble breaks.

    I hope not- I for one hope that eventually we will end up with an IT program in the USA that is not mandated, but actually desired by practitioners.

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